Malnutrition (Kwashiorkor and Marasmus) — Symptoms and Treatment

One of the most common reasons for the death of almost 300,000 children per year is malnutrition. It is seen more frequently among children who are younger than five years and reside in the developing countries. The number contributes to half of the total deaths in the child age groups across the world.Protein-energy malnutrition (PEM) is a type of malnutrition commonly seen among children aged six months to 5 years.

Types of Malnutrition

Kwashiorkor

Kwashiorkor is a debilitating and life-threatening condition caused by the lack of protein in the diet.

Distribution of kwashiorkor

It is commonly seen in the following areas:

Famine-stricken

Limited food supply countries

Greater illiteracy rate countries

Pathophysiology of kwashiorkor

Lack of protein results in an osmotic imbalance and irregularities in the lymphatic system. Three major functions served by the lymphatic system of the body are:

Fluid recovery

Immunity

Lipid absorption

In the case of protein sub-nutrition, the victim exhibits reduced ability towards fluid recovery; there is a lack of immunity, and lipid absorption does not take place sufficiently.

Lack of proteins results in zero substantial pressure gradient and, therefore, a failure to draw fluids from tissues into the bloodstream. This leads to the pooling of fluids in the abdomen.

Failure of fluid recovery by the lymphatics results in edema and belly distension, which is the typical presentation of an undernourished child. Edema caused as a result may trick the parents into thinking that the child is well nutritioned despite the lack of protein intake.

Signs and symptoms of kwashiorkor

For an undernourished child suffering from Kwashiorkor, pitting edema is the characteristic sign. Other signs and symptoms include:

Edema: Initially, it involves the dorsum of the feet and ankles and later spreads upwards to involve the whole body. Edema accounts for 5 – 20% of the body weight. Loss of fluid can mark a striking change in appearance.

Treatment of kwashiorkor

Treatment options depend on the severity of the condition. In the early stages of the disease, treatment revolves around providing an adequate diet for the child, with more calories and protein.

However, this will not compensate for the damage that has already been done to the growth and height potential of the victim. Carbohydrates, in the form of simple sugars and fats, are given first to cater for the catabolic needs. This is because the protein catabolism includes the urea cycle and this can overwhelm the already damaged liver.

So, proteins are given after other sources of energy have been provided. They serve only for the anabolic purpose. Vitamins and minerals are also essential to restore the nutritional status of the patient.

Food must be introduced slowly and gradually to prevent issues arising from the administration of high calories after a long period of time.

Those in the later stages of the disease may present with shock. The treatment then aims to restore the blood volume and maintain blood pressure.

Prognosis of kwashiorkor

Early treatment can produce better results. Treatment in the later stages improves the nutritional status of the child; however, it does not compensate the physical and mental damage that has already been done. It can be a life-threatening condition if not treated on time.

Possible complications of kwashiorkor

Prevention of kwashiorkor

An adequate diet containing enough carbohydrates, fats that must provide 10% of the total caloric needs and proteins that make up for the 15% of the caloric intake. Proteins can be found in the following foods: